When carotid, abdominal aortic and thoracic aortic devices share one interventional shelf, the abbreviations on the order line are easy to mix. EVAR and TEVAR come from the same device family — stent grafts — but sizing, urgency and stock policy differ. A carotid stent system is an incomplete set without an embolic protection device and a suitable access sheath. This article defines the terms that recur across the three product groups, so that hospital purchasing, the warehouse and the clinical team can use the same terminology.
Carotid devices: stent, embolic protection and access
In endovascular treatment of internal carotid stenosis the main device is the carotid stent system. Carotid stents are usually self-expanding and arrive preloaded on a delivery system. The word “system” in the IFU means the stent and the delivery system are packed together.
An embolic protection device (EPD) is used so that fragments leaving the plaque during the procedure do not reach the brain. Distal filters, proximal flow occlusion and flow-reversal systems are different devices and need different steps. The stent and the protection device are tracked as two separate items in the warehouse.
The diameter of the sheath or guiding catheter required for access is written in the stent IFU. Sheaths with the same French (F) value can differ in length and tip shape. If carotid devices share a shelf with peripheral stents, the label should state the anatomical territory.
- CAS (carotid artery stenting): The name of the procedure, not a product group.
- CEA (carotid endarterectomy): The open surgical option. A treatment option, not a stock item.
- Dual antiplatelet therapy (DAPT): Medical treatment before and after the procedure. Planned separately from the device order.
Peripheral balloon and stent terminology is treated by segment in peripheral balloon or stent. Wire and sheath compatibility on carotid devices falls within ranges that differ from the peripheral portfolio.
EVAR: the abdominal aortic stent graft
EVAR (endovascular aneurysm repair) places a stent graft (endograft) from inside the vessel in an infrarenal abdominal aortic aneurysm. The stent graft consists of a metal skeleton and the graft fabric that excludes the aneurysm sac from the circulation. Writing only “stent” does not define the device. Juxtarenal aneurysms need fenestrated or branched grafts rather than standard EVAR. Those are usually made for the individual patient and are listed in a separate catalogue.
Fields commonly found on an EVAR order form:
- Proximal aortic neck: The aortic segment where the graft seats below the renal arteries. Diameter, length and angulation are measured.
- Main-body diameter: Chosen from the neck diameter. In modular systems the main body is a separate product code.
- Iliac limb: The extension that seats in the common iliac artery. The contralateral limb and extension pieces are written on separate lines, with diameter and length.
- Modular or unibody design: The number of pieces sets both logistics and the depth of emergency stock.
“Endograft”, “stent graft” and “EVAR device” describe the same family; only the trade name changes by manufacturer. Using an EVAR code when a thoracic graft is required is a frequent cause of warehouse error. The general classification of interventional product groups is summarised in angioplasty product groups.
Stock and urgency in EVAR
In an elective case, sizing is done from computed tomography angiography and the full configuration is ordered. For emergencies such as a ruptured aneurysm, some centres hold a limited number of standard main bodies and limbs. That policy should be written between the vascular surgical team and purchasing. For each lot, the IFU revision, the list of compatible delivery systems and the sterile-pack check are added to the technical-file checklist.
TEVAR: the thoracic aortic stent graft
TEVAR (thoracic endovascular aortic repair) is used in descending thoracic aneurysm, penetrating atherosclerotic ulcer, traumatic aortic injury and complicated type B dissection. The logic is the same as EVAR. What differs is the anatomy, the diameter ranges and the urgency profile.
Terms that stand out on a TEVAR order line:
- Landing zone: The segment of healthy aortic wall where the proximal and distal ends of the graft seat. The aortic arch and descending aorta are divided into zones 0 to 4 (Ishimaru classification) by the arch branches.
- Left subclavian artery: If the proximal landing zone will cover the origin of this artery, the need for extra revascularisation is planned before the procedure.
- Bare stent: The uncovered metal ring at the end of the graft. It strengthens fixation and lets flow continue when it crosses a branch origin.
- Tapered graft: A graft whose proximal and distal diameters differ. Used in particular in dissection and trauma.
Traumatic aortic injury and complicated dissection can need urgent treatment, so stock depth and delivery time for TEVAR should be a separate clause in the distributor agreement. Even if the conversation says “thoracic EVAR”, the order form should use TEVAR and the manufacturer’s thoracic graft code.
Warehouse, UDI and IFU terminology
For all three product groups the order is aligned under the same headings:
- Anatomical territory: Carotid, abdominal aorta or thoracic aorta.
- Device class: Carotid stent system, embolic protection device, stent graft (EVAR or TEVAR).
- Size: In millimetres. On a graft, neck, body and limb; on a carotid stent, diameter and length.
- Compatibility: Delivery system, sheath and wire. The IFU table is attached to the order.
- UDI, lot and expiry: Required so that a recall can be matched to the patient record.
If the revision number in the technical file does not match the lot in stock, the device is not released for use. That discipline prevents a carotid set delivered without the protection device, the wrong limb length in EVAR, and an incompatible delivery system in TEVAR. The review order of a technical file is described in the medical device technical file.
The same word, a different device
The words mixed most often in warehouse training:
- Stent: In the carotid territory, an uncovered metal stent system. In EVAR and TEVAR, a stent graft — metal skeleton plus graft fabric.
- Filter: In the carotid territory, the embolic protection device. A standard aortic graft set has no filter; the word on an aortic order is a sign of error.
- Main body: In EVAR, the body of a modular bifurcated graft. In TEVAR, this refers to a single-tube graft or a proximal module.
- Limb (leg): Used only in EVAR, for the piece that extends into the iliac artery. In TEVAR the counterpart is a distal extension module.
- Sheath: The access sheath. Usually 6–8 F in the carotid territory, and often 14 F and above for aortic grafts; the exact value is taken from the IFU.
The relation of medical and endovascular treatment in peripheral artery disease is summarised in the medical and endovascular pathway. Current product scope is on the angioplasty page.
Sources
- Mazzolai L, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024. doi:10.1093/eurheartj/ehae179
- Wanhainen A, et al. ESVS 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019. doi:10.1016/j.ejvs.2018.09.020
- Riambau V, et al. Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the ESVS. Eur J Vasc Endovasc Surg. 2017. doi:10.1016/j.ejvs.2016.06.005
- Naylor R, et al. ESVS 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023. doi:10.1016/j.ejvs.2022.04.011
- VascularVita product scope: Angioplasty product groups